|
X-ray abdomen 1 view
|
$282.26 |
$282.26 |
$282.26 |
$255.00
|
|
X-ray abdomen 2 views
|
$209.11 |
$209.11 |
$209.11 |
$312.36
|
|
X-ray abdomen >=3 views
|
$160.94 |
$160.94 |
$160.94 |
$332.15
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$431.78 |
$431.78 |
$431.78 |
$418.63
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$190.91 |
$190.91 |
$190.91 |
$271.44
|
|
X-ray ankle 2 views (both sides)
|
$219.10 |
$219.10 |
$219.10 |
$283.00
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$390.74 |
$390.74 |
$390.74 |
$768.30
|
|
X-ray bone age studies
|
$122.76 |
$122.76 |
$122.76 |
$246.75
|
|
X-ray bone length studies
|
$149.88 |
$149.88 |
$149.88 |
$287.25
|
|
X-ray bone survey complete
|
$504.93 |
$504.93 |
$504.93 |
$666.60
|
|
X-ray bone survey infant
|
$156.66 |
$156.66 |
$156.66 |
$410.73
|
|
X-ray cervical spine 2-3 views
|
$224.81 |
$224.81 |
$224.81 |
$326.04
|
|
X-ray cervical spine 4-5 views
|
$350.77 |
$350.77 |
$350.77 |
$455.65
|
|
X-ray cervical spine >= 6 views
|
$263.35 |
$263.35 |
$263.35 |
$515.35
|
|
X-ray clavicle complete (both sides)
|
$353.63 |
$353.63 |
$353.63 |
$299.65
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$366.83 |
$366.83 |
$366.83 |
$647.40
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$670.86 |
$670.86 |
$670.86 |
$820.15
|
|
X-ray elbow 2 views (both sides)
|
$256.57 |
$256.57 |
$256.57 |
$291.94
|
|
X-ray elbow >= 3 views (both sides)
|
$312.59 |
$312.59 |
$312.59 |
$342.00
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$387.17 |
$387.17 |
$387.17 |
$486.24
|
|
X-ray exam entire spi 4/5 vw
|
$233.38 |
$233.38 |
$233.38 |
$486.01
|
|
X-ray exam entire spi 6/> vw
|
$138.81 |
$138.81 |
$138.81 |
$575.76
|
|
X-ray exam of arm infant
|
$123.47 |
$123.47 |
$123.47 |
$248.82
|
|
X-ray exam of eye sockets
|
$219.46 |
$219.46 |
$219.46 |
$349.05
|
|
X-ray exam of jaw joint
|
$137.03 |
$137.03 |
$137.03 |
$192.39
|
|
X-ray exam of mastoids
|
$179.49 |
$179.49 |
$179.49 |
$191.91
|
|
X-ray exam of perineum
|
$194.48 |
$194.48 |
$194.48 |
$420.93
|
|
X-ray exam of sinuses
|
$116.69 |
$116.69 |
$116.69 |
$211.00
|
|
X-ray exam si joints
|
$142.38 |
$142.38 |
$142.38 |
$246.16
|
|
X-ray exam thorac spine4/>vw
|
$284.05 |
$284.05 |
$284.05 |
$395.59
|
|
X-ray eye detection foreign body (both sides)
|
$99.92 |
$99.92 |
$99.92 |
$235.00
|
|
X-ray facial bones complete > 3 views
|
$293.68 |
$293.68 |
$293.68 |
$366.60
|
|
X-ray femur >=2 views (both sides)
|
$349.70 |
$349.70 |
$349.70 |
$304.15
|
|
X-ray finger(s) >= 2 views (both sides)
|
$237.30 |
$237.30 |
$237.30 |
$262.40
|
|
X-ray foot 2 views (both sides)
|
$273.70 |
$273.70 |
$273.70 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$246.22 |
$246.22 |
$246.22 |
$319.00
|
|
X-ray hand 2 views (both sides)
|
$182.70 |
$182.70 |
$182.70 |
$316.50
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$187.70 |
$187.70 |
$187.70 |
$270.00
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$141.31 |
$141.31 |
$141.31 |
$350.35
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$115.98 |
$115.98 |
$115.98 |
$409.24
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$294.75 |
$294.75 |
$294.75 |
$508.00
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$65.31 |
$65.31 |
$65.31 |
$207.35
|
|
X-ray humerus >= 2 views left
|
$304.39 |
$304.39 |
$304.39 |
$304.15
|
|
X-ray knee 1-2 views (both sides)
|
$286.19 |
$286.19 |
$286.19 |
$283.50
|
|
X-ray knee 3 views (both sides)
|
$315.09 |
$315.09 |
$315.09 |
$353.25
|
|
X-ray knee ap standing bilateral
|
$199.12 |
$199.12 |
$199.12 |
$276.25
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$188.06 |
$188.06 |
$188.06 |
$249.13
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$75.65 |
$75.65 |
$75.65 |
$364.75
|
|
X-ray lumbosacral spine >= 4 views
|
$539.54 |
$539.54 |
$539.54 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$327.94 |
$327.94 |
$327.94 |
$559.65
|
|
X-ray mandible complete > 4 views
|
$286.19 |
$286.19 |
$286.19 |
$352.83
|
|
X-ray mandible ltd <4 views
|
$226.24 |
$226.24 |
$226.24 |
$238.00
|
|
X-ray nasal bones complete > 3 views
|
$310.09 |
$310.09 |
$310.09 |
$277.70
|
|
X-ray neck soft tissue
|
$249.79 |
$249.79 |
$249.79 |
$237.43
|
|
X-ray of mammary ducts
|
$251.57 |
$251.57 |
$251.57 |
$473.55
|
|
X-ray pelvis 1-2 views
|
$196.26 |
$196.26 |
$196.26 |
$270.84
|
|
X-ray pelvis complete > 3 views
|
$15.71 |
$15.71 |
$15.71 |
$342.30
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$89.93 |
$89.93 |
$89.93 |
$742.00
|
|
X-ray ribs 2 views left
|
$64.59 |
$64.59 |
$64.59 |
$296.32
|
|
X-ray ribs 3 views bilateral
|
$466.39 |
$466.39 |
$466.39 |
$394.34
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$293.32 |
$293.32 |
$293.32 |
$359.47
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$466.39 |
$466.39 |
$466.39 |
$497.00
|
|
X-ray sacroiliac joints >= 3 views
|
$313.66 |
$313.66 |
$313.66 |
$313.95
|
|
X-ray sacrum/coccyx >= 2 views
|
$241.23 |
$241.23 |
$241.23 |
$285.60
|
|
X-ray scapula complete (both sides)
|
$184.85 |
$184.85 |
$184.85 |
$292.50
|
|
X-ray shoulder 1 view (both sides)
|
$192.70 |
$192.70 |
$192.70 |
$264.48
|
|
X-ray sinuses paranasal complete > 3 views
|
$265.49 |
$265.49 |
$265.49 |
$339.00
|
|
X-ray sinus tract/fistula/abscess
|
$195.91 |
$195.91 |
$195.91 |
$601.30
|
|
X-ray skull < 4 views
|
$216.60 |
$216.60 |
$216.60 |
$291.78
|
|
X-ray skull > 4 views complete
|
$354.70 |
$354.70 |
$354.70 |
$414.60
|
|
X-ray slg plne bdy sect without urogr
|
$566.66 |
$566.66 |
$566.66 |
$387.00
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$519.91 |
$519.91 |
$519.91 |
$557.70
|
|
X-ray small intestine follow-through study
|
$390.03 |
$390.03 |
$390.03 |
$504.14
|
|
X-ray spine single view
|
$144.17 |
$144.17 |
$144.17 |
$252.60
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$129.54 |
$129.54 |
$129.54 |
$263.49
|
|
X-ray sternum > 2 views
|
$223.03 |
$223.03 |
$223.03 |
$269.75
|
|
X-ray surgical specimen
|
$155.23 |
$155.23 |
$155.23 |
$482.24
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$333.29 |
$333.29 |
$333.29 |
$514.00
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$204.83 |
$204.83 |
$204.83 |
$317.70
|
|
X-ray thoracic spine 2 views
|
$253.71 |
$253.71 |
$253.71 |
$318.50
|
|
X-ray thoracic spine 3 views
|
$78.87 |
$78.87 |
$78.87 |
$387.60
|
|
X-ray thoracolumbar spine >=2 views
|
$314.02 |
$314.02 |
$314.02 |
$294.00
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view
|
$121.33 |
$121.33 |
$121.33 |
$256.85
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$348.28 |
$348.28 |
$348.28 |
$385.80
|
|
X-ray tibia/fibula 2 views (both sides)
|
$285.47 |
$285.47 |
$285.47 |
$328.00
|
|
X-ray toe(s) > 2 views (both sides)
|
$168.79 |
$168.79 |
$168.79 |
$264.00
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$346.85 |
$346.85 |
$346.85 |
$657.77
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$158.08 |
$158.08 |
$158.08 |
$555.04
|
|
X-ray wrist 2 views (both sides)
|
$256.93 |
$256.93 |
$256.93 |
$290.40
|
|
Yersinia antibody
|
$122.76 |
$122.76 |
$122.76 |
$66.95
|
|
Ziprasidone 20 mg/ml (final concentration) intramuscular solution
|
$90.97 |
$90.97 |
$90.97 |
$121.56
|
|
Zoledronic acid 4 mg/5 ml intravenous solution
|
$156.61 |
$156.61 |
$156.61 |
$405.10
|
